Weight Loss and Self-Monitoring among Young Men in a Technology-Driven Weight Loss Intervention

Background Young men with obesity have double the mortality risk compared to young men with a healthy weight, but are notoriously challenging to recruit for behavioral weight loss (BWL) programs. Emerging evidence suggests that young men might prefer self-guided or low touch interventions, but limited data are available as to their effectiveness. To inform future efforts, we conducted a secondary analysis of young men’s performance in a technology-driven BWL trial developed specifically for young adults. Objectives were to: 1) examine young men’s enrollment rates; and 2) compare young men and women’s weight loss outcomes and self-regulation behaviors. Methods Data were drawn from an ongoing randomized controlled trial targeting young adults (18-25 years, body mass index 25-45 kg/m2) for weight loss. Participants (N=184, 60% racial / ethnic minority, BMI=33.2) were recruited using a multi-method approach and randomized to one of three arms, all of which received a 6-month technology mediated intervention with content adapted specifically for young adults. For the purposes of the present analysis, outcomes of interest included weight change at 3 months (objectively assessed in-clinic) and engagement with self-regulation behaviors (captured via Bluetooth scales and self-monitoring app). Treatment arm was included as a covariate in all outcome analyses. Descriptive statistics were computed to capture enrollment rates. GLM was used to compare men and women on percent weight change at 3-months, days of self-weighing, and days of dietary self-monitoring. Results Young men represented 17% of enrolled participants. At 3-months, men manifested greater weight losses compared to women (-4.8±5.1% vs. -2.5±4.1%, p=.008). Over the course of the 3-months, engagement with self-regulation behaviors was similar for men and women; men had a similar number of days of self-weighing (46.77±24.6 vs. 47.42±24.0, p=.88) and a lower number of days for tracking diet (36.87±24.3 vs. 43.42±22.6, p=.15) relative to women. Conclusion While enrollment was low among young men in this technology-driven BWL program, those men who enrolled lost double the weight compared to women—even though engagement with self-monitoring behaviors was similar or lower. These results suggest that a low touch and primarily self-guided weight loss program may be sufficient to produce clinically meaningful weight loss among young men. Findings are discussed in terms of implications for future work.https://scholarscompass.vcu.edu/gradposters/1041/thumbnail.jp

A systematic review of weight-related communication trainings for physicians: What do we know and how can we inform future development of training programs?

It is reported that physicians lack training to address weight-related concerns with patients. To overcome this, training programs have been implemented in medical settings to prepare physicians to have conversations with patients. However, it is unclear the degree of consistency among existing training programs and factors associated with better outcomes. The objective of this study was to systematically review the existing literature in this area to determine differences in content, outcomes, and implementation of existing studies that test weight-related communication training programs for physicians. A systematic literature review of online databases including PubMed, PsycINFO, and Proquest was conducted with the assistance of a librarian. Search terms included: health communication, training, physician training, weight, and obesity. Studies were selected based on the following inclusion criteria: physicians are post-graduate medical doctors; trainings encompassed weight-related communication; and outcomes were tied to physician uptake of skills, knowledge, and self-efficacy, or patient-related outcomes. Two coders reviewed studies using detailed inclusion criteria. Disagreements were resolved by consensus among authors. Half of studies assessed outcomes in both patients and physicians. Trainings including motivational interviewing (MI) assessing patient outcomes found increases in patient knowledge, satisfaction, motivation, and weight loss, respectively. Whereas, non-MI trainings assessing patient outcomes found an increase in patient weight loss, confidence and motivation, or no changes in patient outcomes. This review was the first to examine programs aimed to teach physicians to communicate with patients about weight. Future studies should examine the effect of physician communication on BMI.https://scholarscompass.vcu.edu/gradposters/1025/thumbnail.jp

Examining gender differences in young men and women’s goals for a technology-driven weight loss intervention

Background Emerging adults (EA) are at high risk for weight gain and obesity yet are underrepresented in behavioral weight loss (BWL) programs and fare worse than their older counterparts when they join these programs. Further, even within BWL programs adapted specifically for this population, young men are particularly challenging to recruit, representing less than 20% of samples in recent trials. One hypothesis for the poor recruitment of men is that men’s goals for a weight loss program are not described in recruitment messages for these studies. Understanding whether men and women’s personal goals for participating in a weight loss program could be a key way to tailor recruitment messaging. As such, the objective of this study is to compare young men and women’s personal goals for a BWL program. Methods Participants (N=382; 21.9+1.2 years; 83% female; BMI=33.5+4.9 kg/m2) were recruited for a technology-driven weight loss intervention adapted for this age group. At baseline, participants ranked their top 3 personal goals from a list of 15 areas in which they wanted to see change during the program. The most commonly reported areas (n=8) were coded as yes or no if the goal was ranked as one of their top 3. Chi-square tests were conducted to compare men and women on the most commonly reported goals for the program; using Bonferroni correction to adjust for multiple comparisons (p\u3c.006). Results Overall, the most commonly reported areas for wanting to change in the program were: weight (62.7%), physical fitness (43.7%), body fat percentage (25.7%), body shape (25.1%), energy level (24.1%), clothing size (19.6%), confidence (18.8%), and self-esteem (18.0%). Weight was the most commonly ranked as a top goal (43.5%), followed by physical fitness (11.3%) and body fat percentage (8.9%). No significant differences were found between men and women for personal goals. Conclusion Emerging adults have a desire to lose weight and body fat, as well as improve physical fitness when it comes to personal goals for a weight loss program. While there were no gender differences in goals for a weight loss program, this could be due to enrollment of a treatment seeking sample. Coupled with differential enrollment of young men, it is possible the results may not be representative of non-treatment seeking young men. More research is needed to understand potential gender differences in goals for a weight loss program to improve recruitment messaging targeting young men.https://scholarscompass.vcu.edu/gradposters/1118/thumbnail.jp

The relationship between body mass index, binge eating disorder and suicidality

Abstract Background While restrictive and compensatory eating disorders (e.g. anorexia and bulimia) are associated with elevated risk of suicide, less is known about binge eating disorder (BED). There is suggestive evidence of a U-shaped relationship between body mass index (BMI) and completed suicide, but fewer studies on suicidal ideation or attempts. This study examined the association between BED, BMI, and suicidality, and assessed whether these relationships varied by gender. Methods Data come from the Collaborative Psychiatric Epidemiologic Surveys (N = 14,497). Binge episodes and BED were assessed using the Composite International Diagnostic Inventory (CIDI). BMI was calculated from self-reported height and weight. Suicidal ideation/attempts were assessed using the CIDI. Weighted logistic regression was used to assess the association between binging/BED, BMI and suicidality. Interaction terms were used to assess whether the relationship between BMI and suicidality was moderated by binging/BED, and whether the relationships between binging/BED and BMI differed by gender. Results One-third of adults with BED had a history of suicidality, compared to 19% of those without. Both binging (OR: 1.95, 95% CI: 1.50–2.53) and BED (OR: 2.01, 95% CI: 1.41–2.86) were associated with suicidality in fully-adjusted models. BMI was associated with suicidality in a curvilinear manner, and this relationship was exacerbated by binging/BED (ORBinge eating x BMI: 1.04, 95% CI: 1.01–1.09, p < 0.05). The relationship between BMI and suicidality did not differ by gender (ORgender x BMI: 1.00, p < 0.770). However, the relationship between binge eating and suicidality was stronger for women relative to men (ORgender X binge: 1.87, p < 0.012). Conclusions Binge eating, even below the threshold for BED, is associated with suicidality. BMI is associated with suicidality in a curvilinear manner, and the BMI-suicidality relationship is potentiated by binge eating/BED. Findings support the thoughtful integration of psychiatric care into weight loss programs for adults with a history of binging behavior.https://deepblue.lib.umich.edu/bitstream/2027.42/144500/1/12888_2018_Article_1766.pd

Framing and visual type: Effect on future Zika vaccine uptake intent

Introduction: The Zika virus is associated with the birth defect microcephaly, and while a vaccine was not available in early- 2017, several were under development. This study’s purpose was to identify effective communication strategies to promote uptake of a new vaccine, particularly among women of reproductive age.Design and methods: In order to study the effects of Zika message framing (gain vs. loss) and visual type (photo vs. infographic) on future Zika vaccine uptake intent, a 2×2 between-subjects experiment was performed via an online survey in 2017 among 339 U.S. women of reproductive age (18-49 years). Participants were exposed to one of four messages, all resembling Instagram posts: gain-framed vs. loss-framed infographic, and gain-framed vs. loss-framed photo. These messages were followed by questions about Zika vaccine uptake intent as well as intermediate psychosocial variables that could lead to intent. Results: There was no interaction between framing and visual type (P=0.116), and there was no effect for framing (P=0.185) or visual type (P=0.724) on future Zika vaccine uptake intent, which is likely indicative of insufficient dosage of the intervention. However, when focusing on intermediate psychosocial constructs that are known to influence behavior and intent, gain-framed messages were more effective in increasing subjective norms (P=0.005) as related to a future Zika vaccine, as well as perceived benefits (P=0.016) and self-efficacy (P=0.032). Conclusions: Gain-framed messages seem to be more effective than loss-framed messages to increase several constructs that could, in turn, affect future Zika vaccine uptake intent. This is a novel finding since, traditionally, loss-framed messages are considered more beneficial in promoting vaccine-related health behaviors

Prevalence of Mental Health Disorder Symptoms and Rates of Help-seeking Among University-Enrolled, Black Men

Background. Black men in college represent a subgroup of emerging adults who are at increased risk of developing mental health disorders (MHDs), such as anxiety and depression. Such risk has been attributed to disproportionate experiences with everyday racial discrimination and high levels of psychological distress. Despite being at higher risk, university-enrolled, Black men are not utilizing mental health or health resources at optimal rates. The current evidence base describing prevalence of MHDs and health services utilization among Black men in college is limited. The present study addresses this by examining mental health prevalence among university-enrolled, Black men and their rates of health services utilization. Methods. We analyzed data (N ~ 2500) from a student survey, Spit for Science, a longitudinal, ongoing, research study at a mid-Atlantic, public university. Participants are given surveys in their freshman year and follow-up surveys every spring thereafter. Measures included: mental health disorders (depression and anxiety, as measured by the Symptom Checklist 90) and campus health service utilization (counseling center, health services, wellness center, and recreational sports). We conducted descriptive analyses to determine MHD symptom prevalence and utilization rates; Mann Whitney U tests to compare prevalence rates to White men and Black women; and, Chi-squared tests to compare rates of utilization among groups. Results. During their Freshman year, greater than 60% of students from each ethnic group reported at least one anxiety symptom and greater than 80% reported at least one depressive symptom. By senior year, reporting rates decreased significantly for Black men (49.6%) but remained high for White men (69.1%) and Black women (63%); p \u3c0.000. For depression, results were similar; however, only significant differences between Black men (72.7%) and Black women (87.1%); p\u3c0.000. Black men (20.4%), though reporting high levels of symptoms, still utilized counseling services at lower rates compared to White men (37.76%); p = 0.024. Conclusion. Findings suggest that Black men underutilize available campus health resources despite reporting one or more symptoms associated with anxiety and depression. Further research and prevention efforts are needed to improve help-seeking among this vulnerable population.https://scholarscompass.vcu.edu/gradposters/1077/thumbnail.jp

Recruitment of young adults into a randomized controlled trial of weight gain prevention: message development, methods, and cost

Abstract Background Young adulthood (age 18 to 35) is a high-risk period for unhealthy weight gain. Few studies have recruited for prevention of weight gain, particularly in young adults. This paper describes the recruitment protocol used in the Study of Novel Approaches to Prevention (SNAP). Methods We conducted extensive formative work to inform recruitment methods and message development. We worked with a professional marketing firm to synthesize major themes and subsequently develop age-appropriate messages for recruitment. A variety of approaches and channels were used across two clinical centers to recruit young adults who were normal or overweight (body mass index (BMI) 21 to 30 kg/m2) for a 3-year intervention designed to prevent weight gain. We tracked recruitment methods, yields, and costs by method. Logistic regression was used to identify recruitment methods that had the highest relative yield for subgroups of interest with covariate adjustments for clinic. Results The final sample of 599 participants (27% minority, 22% male) was recruited over a 19-month period of sustained efforts. About 10% of those who initially expressed interest via a screening website were randomized. The most common reason for ineligibility was already being obese (BMI >30 kg/m2). The top two methods for recruitment were mass mailing followed by email; together they were cited by 62% of those recruited. Television, radio, paid print advertising, flyers and community events each yielded fewer than 10% of study participants. Email was the most cost-effective method per study participant recruited. Conclusions These findings can guide future efforts to recruit young adults and for trials targeting weight gain prevention. Trial registration ClinicalTrials.gov NCT01183689 (registered 13 August 2010)

Framing and visual type: Effect on future Zika vaccine uptake intent

Introduction: The Zika virus is associated with the birth defect microcephaly, and while a vaccine was not available in early- 2017, several were under development. This study’s purpose was to identify effective communication strategies to promote uptake of a new vaccine, particularly among women of reproductive age. Design and methods: In order to study the effects of Zika message framing (gain vs. loss) and visual type (photo vs. infographic) on future Zika vaccine uptake intent, a 2×2 between-subjects experiment was performed via an online survey in 2017 among 339 U.S. women of reproductive age (18-49 years). Participants were exposed to one of four messages, all resembling Instagram posts: gain-framed vs. loss-framed infographic, and gain-framed vs. loss-framed photo. These messages were followed by questions about Zika vaccine uptake intent as well as intermediate psychosocial variables that could lead to intent. Results: There was no interaction between framing and visual type (P=0.116), and there was no effect for framing (P=0.185) or visual type (P=0.724) on future Zika vaccine uptake intent, which is likely indicative of insufficient dosage of the intervention. However, when focusing on intermediate psychosocial constructs that are known to influence behavior and intent, gain-framed messages were more effective in increasing subjective norms (P=0.005) as related to a future Zika vaccine, as well as perceived benefits (P=0.016) and self-efficacy (P=0.032). Conclusions: Gain-framed messages seem to be more effective than loss-framed messages to increase several constructs that could, in turn, affect future Zika vaccine uptake intent. This is a novel finding since, traditionally, loss-framed messages are considered more beneficial in promoting vaccine-related health behaviors

Mental health disorder symptom prevalence and rates of help-seeking among University-Enrolled, emerging adults

Objective. Examine mental health symptom prevalence and rates of campus services utilization among Black male, White male and Black female college students. Participants. 2500 students from an ongoing, student survey at a public university; launched in 2011.Methods. Measures included data for anxiety and depressive symptoms and utilization of campus health services (counseling center, health services, etc.). Descriptive analyses determined prevalence and utilization rates. Mann Whitney U tests compared prevalence. Chi-squared tests compared utilization rates. Results. Anxiety prevalence: greater than 60% of students from each ethnic group reported symptoms; reporting rates decreased significantly for Black men (49.6%); p &lt; 0.001. Depression prevalence: greater than 80% reported symptoms; there were significant differences in reporting between Black men and Black women (72.7% vs. 87.1%, p &lt; 0.001). Utilization: Black men utilized counseling services less than White men (20.4% vs. 37.8%, p = 0.024). Conclusion. Black men report depressive and anxiety symptoms but underutilize campus health resources